& 


RESTRICTION  AND  PREVENTION 

OF 

HOOPING-COUGH 


Laws  Requiring-  the  Reporting.  Placarding  and  Disinfecting,  in  Every  Case  of  Disease 
Dangerous  to  the  Public  Heallh;  Facts  Relating  to  the  Age  of  Greatest 
Danger,  and  Importance  of  Restricting  Whooping-Cough. 

DOCUMENT  ISSUED  BY  THE  MICHIGAN  STATE  BOARD  OF  HEALTH. 

THIRD  EDITION  (10,000),  MAY,  1899.  .30,000  PRINTED. 

[‘3^9.]  

1.  Whooping-Cough  is  a Dangerous,  Contagious  Disease,  hence 
it  is  a “disease  dangerous  to  the  public  health”  under  the  laws  in  Mich- 
igan, and  the  observance  of  the  following  precautions  is  of  importance. 

2.  Inasmuch  as  whooping-cough  is  one  of  the  most  contagious 
diseases  and  when  uninfluenced  by  treatment  runs  a course  of  from  two 
to  three  months,  an  average  of  ten  weeks,  and  is  spread  by  those  sick 
with  it  before  the  “whoop”  appears,  therefore,  in  order  that  its  restriction 
shall  be  most  complete,  it  is  important  that  the  early  symptoms  be 
generally  known.  The  first  or  catarrhal  stage  resembles  an  ordinary  cold. 
The  symptoms  are  a cough,  usually  rather  severe  with  a tendency  to  become, 
paroxysmal,  sneezing,  sometimes  watering  of  the  eyes,  and  often  a slight 
fever.  Eestlessness,  with  a loss  of  appetite,  and  increased  thirst,  usually 
accompany  these  symptoms.  It  is  often  necessary  to  wait  for  the  second 
stage,  which  is  characterized  by  the  “ whoop  ” before  the  disease  can  be 
distinguished.  When  a child  or  young  person  has  symptoms  of  whooping- 
cough,  or  a old  or  cough  unusually  severe  with  a tendency  to  become 
paroxysmal,  it  should  immediately  be  kept  separated  from  all  other 
persons,  except  necessary  attendants,  until  it  is  ascertained  whether  or  not 
it  has  whooping-cough,  or  some  other  communicable  disease. 

3.  Period  of  Incubation. — The  interval  between  the  date  of  infection 
and  that  of  the  outbreak  of  symptoms  of  whooping-cough  usually  varies 
between  four  and  twenty-one  days. 

4.  Every  person  known  to  be  sick  with  whooping-cough  should  be 
promptly  and  thoroughly  isolated  from  the  public;  no  more  persons 
than  are  actually  necessary  should  have  charge  of  or  visit  the  patient,  and 
they  should  be  restricted  in  their  intercourse  with  other  persons. 

5.  Plain  and  distinct  notices  should  be  placed  upon  the  premises 
or  house  in  which  there  is  a person  sick  with  whooping-cough. 

6.  Householders  and  Physicians  must  immediately  give  notice  of 
the  first  case  and  of  every  case  of  whooping-cough  to  the  local  health 
officer.  This  is  required  by  law.* 

DUTIES  OF  THE  LOCAL  BOARD  OF  HEALTH. 

7 . Upon  the  receipt  of  notice  of  the  occurrence  of  whooping-cough,  the 
health  officers  and  the  Board  of  Health  have  duties  to  perform  in  taking 
measures  to  restrict  the  spread  of  the  disease,  which  it  is  a violation  of  public 
trust  for  such  officers  to  neglect  or  postpone.  That  no  time  may  be  lost, 
it  is  the  duty  of  every  board  of  health  to  make  provisions  for  prompt  action 

* Stction  1675  and  § 1676  Howell’s  Statutes,  as  amended  by  Act  15**,  Laws  of  1895.  Supervisors  must 
prosecute  for  all  forfeitures  un-ier  the  law;  township  officers  must  give  notice  to  supervisors;  prose- 
cuting attorney  to  conduct  suit  if  requested— sections  8439,  8440  and  8443,  Howell’s  statutes.  Hedlth 
officers  of  villages  or  cities  must  notify  prosecuting  attorney  of  all  violations  of  this  law,—  § 1684, 
Howell’s  statutes;  the  prosecuting  attorney  must  prosecute  for  all  such  forfeitures  incurred  within 
his  county,— § 8443,  Howell’s  statutes. 


''  P A- 


2 DUTIES  OE  LOCAL  BOARD  OF  HEALTH  AND  HEALTH  OFFICER. 


by  its  health  officer,  authorizing  and  directing  him  to  be  prepared  at  ail 
times,  as  executive  officer  of  the  board,  to  take  action  without  waiting 
for  a meeting  of  the  board,  whenever  a case  of  diphtheria,  scarlet  fever, 
measles,  whooping-cough,  small-pox,  or  other  disease  dangerous  to  the 
public  health  occurs  within  its  jurisdiction.  The  duties  of  the  local  board 
of  health  relative  to  the  restriction  and  prevention  of  diseases  are  treated 
of  in  a circular  No.  [120]  issued  by  the  State  Board  of  Health. 

DUTIES  OF  THE  HEALTH  OFFICER. 

Some  of  the  duties  of  the  health  officer  generally  required  by  law,  may 
be  briefly  suggested  as  follows:  Whenever  he  has  reason  to  believe  that 
there  is  in  his  jurisdiction  a case  of  whooping-cough,  he  should, — 

a.  Promptly  investigate  the  subject. 

h.  Order  the  prompt  and  thorough  isolation  of  those  sick  or  infected 
with  whooping-cough. 

c.  See  that  no  person  suffers  for  lack  of  nurses  or  supplies. 

d.  Give  public  notice  of  infected  places  by  placard  on  the  premises, 
and  otherwise  if  necessary. 

e.  Notify  teachers  or  superintendents  of  schools  concerning  families  in 
which  there  are  cases  of  whooping-cough. 

/.  Supervise  funerals  of  persons  dead  from  whooping  cough. 

g.  Disinfect  rooms,  clothing  and  premises,  and  all  articles  likely  to  be 
infected,  before  allowing  them  to  be  used  by  other  persons  than  those  in 
isolation. 

h.  Keep  the  president  of  his  board  of  health  and  the  secretary  of  the 
State  Board  of  Health  constantly  informed  respecting  every  outbreak  of 
whooping-cough . 

In  the  absence  of  regulations  made  by  the  local  board  of  health,  con- 
flicting therewith,  orders  by  the  health  officer  in  the  lawful  performance 
of  these  duties  have  the  force  of  regulations  by  the  board  of  health. 

Unless  otherwise  ordered  by  the  local  board  of  health,  these  duties  are 
required  of  the  health  officer  by  Act  137,  laws  of  1883.  Section  2 of  this 
act,  as  amended  by  Act  No.  34,  approved  March  28,  1889,  provides  that  — 

“ Whoever  shall  knowingly  violate  the  provisions  of  section  one  of  this  act,  or  the  orders  of  the 
health  officer  made  in  accordance  therewith,  shall  be  deemed  guilty  of  a misdemeanor,  and  upon 
conviction  thereof  he  shall  be  punished  by  a fine  nor.  exceeding  one  hundred  dollars,  and  the  costs  of 
prosecution,  or  in  default  of  payment  thereof,  by  imprisonment  not  exceeding  ninety  days  in  the 
county  jaii,  in  the  discretion  of  the  court.” 

This  penalty  seems  to  apply  to  the  health  .officer,  or  to  whoever  violates 
his  orders.  The  health  officer  should  also,  in  due  time,  give  certiflcates  of 
recovery  and  of  freedom  from  liability  to  give  whooping-cough,  but  not 
until  after  thorough  disinfection  following  complete  recovery. 

THE  RESTRICTION  OF  WHOOPING-COUGH. 

8.  The  room  in  which  one  sick  with  whooping-cough  is  to  be  placed 
should  previously  be  cleared  of  all  needless  clothing,  carpets,  drapery,  and 
other  materials  likely  to  harbor  the  poison  of  the  disease.  This  room 
should  constantly  receive  a liberal  supply  of  fresh  air,  without  currents  or 
drafts  directly  upon  the  patient. 

9.  The  discharges  from  the  throat,  nose,  and  mouth  are  liable  to  com- 
municate the  disease,  and  should  be  received  in  vessels  containing  a strong 
disinfectant,  or  on  soft  rags  or  pieces  of  cloth  which  should  immediately 
be  burned. 


RESTRICTION  OF  WHOOPING-COUGH— DISINFECTION,  ETC. 


3 


10.  Nurses’  and  attendants’  hands  should  be  washed  and  disinfected  by 
chlorinated  soda,  their  hair,  (and  beard  if  any),  should  receive  attention, 
and  their  clothing  should  be  disinfected,  before  they  go  in  public. 

11.  Every  person  recovering  from  whooping-cough  should  be  con- 
sidered dangerous.  The  duration  of  infectiousness  may  be  three  weeks 
before  the  “whoop”  and  four  or  six  weeks  after  apparent  recovery;  there- 
fore such  a person  should  not  be  permitted  to  associate  with  others,  or  to 
attend  school,  church,  or  any  public  assembly  until  in  the  judgment  of  a 
careful  and  intelligent  health  officer  he  can  do  so  without  endangering 
others;  nor  until  after  all  his  clothing  has  been  thoroughly  disinfected. 
Nor  should  a person  from  premises  in  which  there  is  or  has  been  a case  of 
whooping-cough,  attend  any  school,  Sunday  school,  church,  or  public 
assembly,  or  be  permitted  by  the  health  authorities  or  by  the  school  board  to 
do  so,  until  after  disinfection  of  such  premises  and  of  the  clothing  worn  by 
such  person,  if  it  shall  have  been  exposed  to  the  contagion  of  the  disease. 

12.  No  public  funeral  should  be  held  at  a,  house  in  which  there  is  a 
case  of  whooping-cough,  nor  in  which  a death  from  whooping-cough  has 
recently  occurred.  No  child  should  attend,  and  it  would  be  better  in  most 
cases  that  few  adults  attend  a funeral  of  a person  dead  of  whooping-cough. 

DISINFECTION  OF  ROOMS,  CLOTHING,  ETC. 

13.  After  a death  or  recovery  from  whooping-cough,  the  room  in  which 
there  has  been  a case,  whether  fatal  or  not,  should,  with  all  its  contents, 
be  thoroughly  disinfected  by  exposure  for  several  hours  to  strong  fumes  of 
burning  sulphur,  or  of  formaldehyde,  and  then  it  should  for  several  hours 
or  days  be  exposed  to  currents  of  fresh  air. 

Kooms  to  be  disinfected  must  be  vacated.  Heavy  clothing,  blankets, 
bedding  and  other  articles  which  cannot  be  treated  with  the  zinc-solution, 
should  be  spread  out  so  as  to  be  thoroughly  exposed  during  fumigation, 
which  should  take  place  in  the  room  where  the  clothing,  etc.,  have  been 
used  in  connection  with  the  patient.  For  a room  about  ten  feet  square,  at 
least  three  pounds  of  sulphur  or  eight  ounces  of  a forty  per  cent  solution 
of  formaldehyde  should  be  used;  for  larger  rooms,  proportionately  increased 
quantities,  at  the  rate  of  three  pounds  of  sulphur  or  eight  ounces  of  forty 
per  cent  solution  of  formaldehyde  for  each  1,000  cubic  feet  of  air  space. 
By  means  of  the  Novy  still,  the  formaldehyde  may  be  distilled  through 
the  keyhole. 

Close  all  openings  to  the  room,  place  the  sulphur  in  an  iron  pan  sup- 
ported upon  bricks,  set  it  on  fire  by  hot  coals  or  with  the  aid  of  a spoonful 
of  alcohol  lighted  by  a match,  be  careful  not  to  breathe  the  fumes  of  the 
burning  sulphur,  and  when  certain  the  sulphur  is  burning  well,  leave  the 
room,  close  the  door,  and  allow  the  room  to  be  closed  for  several  hours. 

Care  should  be  taken  to  secure  the  complete  burning  of  as  much  of  the 
sulphur  as  is  possible.  To  avoid  danger  of  fire  the  iron  pot  or  pan  in 
which  the  sulphur  is  burned  should  be  free  from  any  leak,  and  it  may  be 
placed  over  water  in  a tub  or  pan. 

Because  of  the  law  of  the  diffusion  of  gases,  and  the  numerous  crevices 
through  which  sulphur  fumes  may  pass,  such  fumes  of  sufficient  strength 
do  not  remain  in  a room  long  enough,  unless  the  combustion  of  sulphur  is 
somewhat  rapid.  It  should  not  only  be  rapid,  but  should  continue  a con- 
siderable time.  The  best  results  are  obtained  by  using  roll  brimstone 
broken  up,  or  flowers  of  sulphur,  burning  the  sulphur  in  shallow  pans  of 
sufficient  number  and  size  to  rapidly  fill  the  room  with  the  fumes,  and  in 
quantities  sufficient  to  last  for  several  hours. 


4 DISINFECtlON  OF  ROOMS,  ETC.— HOW  TO  AVOID  WHOOPING-COUGH. 

Cotton,  linen,  flannels,  blankets,  etc.,  should  be  treated  with  the  boiling- 
hot  zinc-solution,  introducing  them  piece  by  piece,  securing  thorough 
wetting  and  boiling  for  at  least  half  an  hour.  Heavy  woolen  clothing, 
silks,  furs,  stuffed  bed  covers,  beds  and  other  articles  which  cannot  be 
treated  with  the  zinc-solution,  should  be  hung  in  the  room  during  fumiga- 
tion, pockets  being  turned  inside  out  and  the  whole  garment  being  thor- 
oughly exposed.  After ivard  they  should  be  hung  in  the  open  air,  beaten 
and  shaken.  Carpets  are  best  fumigated  on  the  floor,  but  should  after- 
ward be  removed  to  the  open  air  and  thoroughly  beaten.  In  no  case 
should  the  thorough  disinfection  of  clothing,  bedding,  etc.,  be  omitted. 

14.  Hospitals  for  persons  sick  with  whooping-cough.— Disinfec- 
tion of  a room  always  necessitates  vacating  it,  and  sometimes  makes  it 
impossible  to  remain  in  adjoining  rooms,  therefore  in  some  cases  it  seems 
essential  to  have  hospital,  tent  or  other  temporary  shelter  for  the  inmates 
of  infected  houses,  where  bathing,  disinfection  and  washing  can  be  done 
while  such  houses  are  being  disinfected  and  put  in  order.  As  a means  of 
preventing  the  spread  of  'disease,  the  law*  authorizes  the  inhabitants  of 
townships,  cities,  and  villages  to  be  constantly  provided  with  hospitals  for 
the  reception  of  persons  having  any  disease  dangerous  to  the  public  health; 
and  such  is  whooping-cough.  The  lawf  requires  local  boards  of  health, 
on  the  outbreak  of  any  such  disease,  to  provide  such  hospitals  or  places  of 
reception  for  the  sick  and  infected  as  they  shall  judge  best  for  their 
accommodation  and  the  safety  of  the  inhabitants,  and  to  cause  such  sick 
or  infected  persons,  if  their  condition  will  admit,  to  be  removed  to  such 
hospitals  or  places  of  reception.  Said  hospitals,  and  (in  case  the  sick  can- 
not be  removed  to  the  hospital  without  danger  to  life  or  health)  the  houses 
where  the  sick  may  remain,  and  all  persons  connected  with  said  hospitals, 
or  abodes  of  the  sick  constituting  temporary  hospitals,  to  be  subject  to  the 
regulations  of  the  board  of  health,  or  of  a committee  appointed  by  the 
board  of  health  for  that  purpose.  J 

HOW  TO  AVOID  AND  PREVENT  WHOOPING-COUGH. 

15.  Avoid  the  special  contagium  of  the  disease.  Do  not  let  a child  go 
near  a case  of  whooping-cough;  this  is  especially  important  to  be  observed 
by  guardians  of  children  between  one  and  two  years  of  age.  Do  not  permit 
any  person  or  thing,  or  a dog,  cat  or  other  animal  to  come  direct  from  a 
case  of  whooping-cough  to  a child.  Unless  your  services  are  needed,  keep 
away  from  the  disease  yourself.  If  you  do  visit  a case,  bathe  yourself  and 
change  and  disinfect  your  clothing  before  you  go  where  there  is  a child. 

16.  Do  not  permit  a child  to  ride  in  a hack  or  other  closed  carriage  in 
which  has  been  a person  sick  with  whooping-cough,  except  the  carriage 
has  since  been  thoroughly  disinfected  with  fumes  of  burning  sulphur,  as 
specified  in  paragraph  15. 

17.  Do  not  permit  a child  to  wear  or  handle  clothing  worn  by  a person 
during  sickness  or  convalescence  from  whooping-cough. 

18.  Beware  of  any  person  who  has  a cough  with  a tendency  to  become 
paroxysmal;  do  not  permit  a child  to  kiss,  or  take  the  breath  of  such  a 
person,  nor  to  drink  from  the  same  cup,  blow  the  same  whistle,  or  put  his 
pencil  or  pen  in  its  mouth. 


* Sections  1667,  1668,  1670,  1671,  and  1674,  Howell’s  Statutes, 
t Section  1671,  Howell's  Statutes. 

i By  amended  section  1740  of  the  compiled  laws  of  1871  (§1681  Howell’s  Statutes),  the  sections  of  law 
relative  to  townships  (Secs.  3.5  42,  of  chapter  XLVI  of  the  Compiled  Laws  of  1871)  are  made  to  apply  to 
cities  and  villages. 


IMPORTANCE  OF  RESTRICTING  WHOOPING-COUGH. 


5 


THE  AGE  AT  WHICH  MOST  DEATHS  FROM  WHOOPING-COUGH  OCCUR. 

19.  According  to  the  mortality  statistics  of  Michigan  for  the  twenty- 
four  years  from  1870  to  1893  inclusive,  a little  over  95  per  cent  of  all  the 
deaths  from  whooping-cough  were  of  children  under  five  years  of  age. 
Only  about  3.6  per  cent  of  all  the  deaths  in  those  years  were  of  persons 
of  ages  from  5 to  10  years,  and  less  than  one  per  cent  were  of  persons  of 
ages  from  10  to  20  years. 

While  the  evidence  seems  to  prove  that  to  persons  between  the  ages  of 
ten  and  twenty  years  the  risk  of  death  from  whooping-cough  is  slight,  even 
that  risk  need  not  be  taken  if  the  disease  be  completely  restricted. 

In  the  present  state  of  our  knowledge,  it  seems  important  to  restrict 
whooping-cough  as  completely  as  possible,  and  especially  so  that  it  shall 
not  reach  children  in  the  second  year  of  life. 

IMPORTANCE^  OF  RESTRICTING  WHOOPING-COUGH. 

In  Glasgow  the  annual  mortality  from  whooping-cough  for  40  years 
1855-94,  was  nearly  fourteen  (13.5)  per  ten  thousand  inhabitants,  and 
exceeded  those  from  any  other  dangerous  communicable  disease. 

In  all  England  and  Wales  in  1891,  the  deaths  from  whooping-cough 
(13,612),  were  nearly  five  (4.68)  per  ten  thousand  inhabitants,  and  exceeded 
those  from  measles  (12,673),  diphtheria  (5,036),  scarlet  fever  (4,959)  or 
typhoid  fever  (4,875). 

In  Michigan,  the  reported  deaths  from  whooping-cough  are  several  times 
as  many  as  from  small-pox;  for  the  twenty-four  years,  1870-1893,  they 
averaged  145  per  year.  If  we  assume  that  only  three-fourths  of  the  deaths 
were  reported,  the  deaths  in  Michigan  from  whooping-cough  have  been 
about  193  per  year.  If  the  inhabitants  of  Michigan  now  number  two 
and  a quarter  millions,  and  the  mortality  from  whooping-cough  were  to 
equal  that  in  England  and  Wales  in  1891,  the  deaths  from  that  disease  in 
Michigan  would  equal  a little  over  one  thousand  per  year. 

It  is  claimed  that  the  high  mortality  in  whooping-cough  is  due  to  the 
complications  and  sequelas  which  are  said  to  occur  probably  in  one-third 
or  one-fourth  of  all  cases.  If  that  is  true,  it  would  be  no  extravagance  to 
presume  that  the  mortality  from  whooping-cough  would  be  still  higher  if 
all  the  deaths  directly  or  indirectly  due  to  it  were  completely  reported,  as 
it  is  a fact  that  when  a secondary  affection  attacks,  the  primary  disease 
is  sometimes  lost  sight  of  entirely. 

According  to  Dr.  Farr’s  law — of  increase  of  contagious  diseases  as 
density  of  population  increases — the  death-rate  from  whooping-cough, 
unless  restrictive  measures  are  taken,  will  undoubtedly  rapidly  increase  in 
Michigan  with  the  rapidly  increasing  population,  and  especially  with  the 
rapidly  increasing  lines  of  railroads  and  other  facilities  for  easy,  frequent, 
and  rapid  movements  of  the  people.  The  present  very  considerable  mor- 
tality from  whooping-cough,  and  also  the  much  greater  mortality  which 
may  be  expected,  supply  urgent  reasons  why  the  measures  herein  recom- 
mended should  be  generally  and  thoroughly  adopted  and  enforced. 

This  document  is  published  by  the  State  Board  of  Health,  for  gratuitous  distribution  throughout  the 
State.  A copy  may  be  obtained  by  applying  to  the  Secretary  of  the  State  Board  of  Health, 
Lansing,  Michigan. 


6 THE  RESTRICTION  AND  PREVENTION  OF  WHOOPING-COUGH. 


The  State  Board  of  Health  recommends  that  local  boards  of  health  procure  and  distribute  copies 
of  this  document  within  their  jurisdictions,  when  whooping-cough  is  near,  and  especially  to  the  neigh- 
bors of  families  in  which  this  disease  is  present. 


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